Nutritional risk and body composition in free-living elderly participating in congregate meal-site programs

Nutritional Status and Sarcopenia in Nursing Home Residents: A Cross-Sectional Study

OBJECTIVE

This study aimed to assess the nutritional status and sarcopenia in older people living in nursing homes.

METHODS

This cross-sectional study enrolled 386 older adults in nursing homes in Hunan Province, China. Assessments included the Mini Nutritional Assessment Short Form for nutrition risk, Dietary Diversity Score for dietary diversity and Mini Mental State Examination for cognitive status. Sociodemographic (e.g., age, sex and educational level), health-related characteristics (e.g., food intake, self-care status and medication), body composition (e.g., body mass index [BMI], protein, body fat mass [BFM], percent body fat [PBF], skeletal muscle index [SMI] and total body water [TBW]) and anthropometric parameters data (e.g., calf circumference [CC], upper arm circumference [UAC], handgrip and gait speed) were also collected. Malnutrition and their associated risk were analyzed by multivariable Poisson regression analysis.

RESULTS

In total, 32.4% of participants (n = 125) were at risk of malnutrition and 49.7% (n = 192) suffered from sarcopenia. Nutritional status was positively associated with age (risk ratio [RR] = 1.03), sarcopenia (RR = 1.88), tooth loss affecting food intake (RR = 1.45), low self-care status (RR = 1.82) and moderate/inadequate dietary diversity (RR = 2.04) and negatively associated with one child (RR = 0.27), BMI (RR = 0.82), protein (RR = 0.76), BFM (RR = 0.91), PBF (RR = 0.94), SMI (RR = 0.65), TBW (RR = 0.94), CC (RR = 0.89) and UAC (RR = 0.86).

CONCLUSIONS

Age, number of children, sarcopenia, food intake, self-care status, dietary diversity and body composition were associated with malnutrition among nursing home residents. For vulnerable groups, researchers should focus on raising the body composition indicators, such as BMI, protein, BFM, SMI and TBW and measuring CC and UAC for initial screening.

Associations between nutrition risk status, body composition and physical performance among community-dwelling older adults

OBJECTIVE

To investigate the associations between nutrition risk status, body composition and physical performance among community-dwelling older New Zealanders.

METHODS

This cross-sectional study enrolled 257 community-dwelling older adults (median age 79 years). Assessments included the Mini Nutritional Assessment-Short Form (MNA®-SF) for nutrition risk; the Eating Assessment Tool-10 for dysphagia risk; bioimpedance analysis for body composition (free fat mass (FFM) and percentage body fat) and gait speed for physical performance. A multiple logistics regression analysis was conducted, to determine factors associated with lower odds [OR (95% CI)] for nutrition risk.

RESULTS

Every yearly increase in age was associated with higher odds 1.09 (1.01-1.17) for nutrition risk. Additionally, nutrition risk was less likely to occur among participants of age <85 years 0.30 (0.11-0.79), with no dysphagia 0.29 (0.09-0.97) and those with a healthy gait speed 0.29 (0.09-0.97). Lower odds for nutrition risk were also found with increasing values of FFM index 0.51 (0.34-0.77), and percentage body fat 0.81 (0.72-0.90). Gait speed was positively correlated with FFM index (r=0.19 p<0.022), percentage body fat (r=0.23, p=0.006) and BMI (r=0.29, p<0.001).

CONCLUSION

Among these participants, associations between nutrition risk, body composition and physical performance were found. Implications for public health: Routine screening of nutrition risk and/or physical performance among vulnerable older adults is key towards identifying those in need of assessment and dietary intervention. Alongside strategies to encourage physical activity, this may help to slow losses of FFM and protect physical performance.

Occurrence of Malnutrition and Associated Factors in Community-Dwelling Older Adults: Those with a Recent Diagnosis of Cancer Are at Higher Risk

OBJECTIVES

In older adults, nutritional health is essential for good quality of life and living independently at home. Especially in cancer patients, malnutrition is common and known to complicate treatment. This study aims to evaluate the nutritional status and its associated factors in community-dwelling older adults with and without cancer.

DESIGN

This is an observational study.

SETTING

This study focuses on older community-dwelling people.

PARTICIPANTS

This study included older people with and without cancer (≥70 years). Cancer patients included patients with a new diagnosis of breast, lung, prostate, or colorectal cancer.

MEASUREMENTS

Data collection included measures of nutritional status, quality of life, depression, fatigue, distress and functional status. We used multivariate logistic regression analysis to assess the association between personal characteristics and malnutrition.

RESULTS

Data were available for 657 people; 383 people without cancer and 274 with a cancer diagnosis. Overall, malnutrition was detected in 245 (37.5%) people; in cancer patients this was 66.1%. Multivariate analysis showed that having cancer (OR 14.4, 95% CI: 8.01 - 23.3), being male (OR 2.38, 95% CI: 1.49 - 3.70), having depression (OR 13.5, 95% CI: 6.02-30.0), distress (OR 2.60, 95% CI: 1.55 - 4.37) and impaired instrumental activities of daily living (IADL) (OR 2.63, 95% CI: 1.63 - 4.24) were associated with a higher risk of malnutrition.

CONCLUSION

The prevalence of malnutrition in community-dwelling older people is high, particularly in patients with cancer. Benchmarking and routine screening of older patients may be helpful strategies to increase awareness of (risk of) malnutrition among professionals.

Evaluation of Handgrip Strength and Nutritional Risk of Congregate Nutrition Program Participants in Florida

The aim of this study was to determine if handgrip strength (HGS) is a predictor of nutritional risk in community-dwelling older adults. A cross-sectional study was carried out to determine the relationship between HGS and nutritional risk using SCREEN 1. The setting was Congregate Nutrition program meal sites (n = 10) in North Central Florida and included community-dwelling older adults participating in the Congregate Nutrition program. Older adults (n = 136; 77.1 ± 8.9 y; 45 M, 91 F) participated in the study. Nutritional risk was identified in 68% of participants, with 10% exhibiting clinically relevant weakness (men, HGS < 26 kg; women, HGS < 16 kg), suggesting a vulnerable population. HGS was weakly associated with nutritional risk as assessed by SCREEN 1 (AUC = 0.59), but alternate cutpoints, 33 kg for men (mean of both hands) and 22 kg for women (highest of either hand), provided the best comparison to nutritional risk. In community-dwelling older adults, HGS was weakly associated with nutritional risk assessed using traditional screening. However, as existing research supports the inclusion of HGS in malnutrition screening in acute care, further research into the usefulness of HGS and possibly other measures of functional status in nutrition risk screening of community-dwelling older adults may be warranted.

Malnutrition in a sample of community-dwelling people with Parkinson's disease

Objective

Malnutrition results in poor health outcomes, and people with Parkinson’s disease may be more at risk of malnutrition. However, the prevalence of malnutrition in Parkinson’s disease is not yet well defined. The aim of this study is to provide an estimate of the extent of malnutrition in community-dwelling people with Parkinson’s disease.

Methods

This is a cross-sectional study of people with Parkinson’s disease residing within a 2 hour driving radius of Brisbane, Australia. The Subjective Global Assessment (SGA) and scored Patient Generated Subjective Global Assessment (PG-SGA) were used to assess nutritional status. Body weight, standing or knee height, mid-arm circumference and waist circumference were measured.

Results

Nineteen (15%) of the participants were moderately malnourished (SGA-B). The median PG-SGA score of the SGA-B group was 8 (4–15), significantly higher than the SGA-A group, U = 1860.5, p<.05. The symptoms most influencing intake were loss of appetite, constipation, early satiety and problems swallowing.

Conclusions

As with other populations, malnutrition remains under-recognised and undiagnosed in people with Parkinson’s disease. Regular screening of nutritional status in people with Parkinson’s disease by health professionals with whom they have regular contact should occur to identify those who may benefit from further nutrition assessment and intervention.

Factors associated with poor nutritional status among the oldest-old

BACKGROUND & AIMS

Older adults are at increased risk for malnutrition. The aim was to investigate the prevalence of and risk factors for poor nutritional status in oldest-old Chinese.

METHODS

Community-living Chinese aged 90 and over were included in the study. Nutritional status was evaluated by using the Mini Nutritional Assessment short-form (MNA-SF). Demographic and socioeconomic status, health status, cognitive, behavioral, and lifestyle factors were collected via structured questionnaires during face-to-face interviews.

RESULTS

632 individuals (424 F, 208 M, 94 ± 3 y) were included. We found that 36 (5.7%) participants were classified as being malnourished (MNA-SF < 7), 445 (70.4%) were classified as being at risk for malnutrition (8 ≤ MNA-SF ≤ 11), and 151 (23.9%) were considered as well-nourished (MNA-SF ≥ 12). Ordinal logistic regression showed that significant risk factors for poor nutritional status included older age, poor cognitive function, gastrointestinal (GI) system disease, poor self-rated health, and lower serum albumin level.

CONCLUSION

The findings suggest that the majority of the Chinese oldest-old were at risk for malnutrition. Nutritional assessment should be incorporated into regular geriatric screening among community-living oldest-old in China. Interventions targeting those at risk for malnutrition should be developed to improve health outcomes among this vulnerable population.

Nutritional status in the healthy longeval population from Sardinia (Italy)

OBJECTIVES

The aim of this study was to evaluate sex- and age-related variations of the nutritional status in the aged population of central Sardinia, a geographical area with a high frequency of long-lived people, particularly men.

DESIGN

The sample consisted of 200 subjects over 70 years of age (men: N= 100, age= 81.0 +/- 7.0 years; women: N= 100, age= 81.5 +/- 7.3 years).

SETTING

Orroli (central Sardinia, Italy).

MEASUREMENTS

Mini nutritional assessment (MNA) and bioelectrical impedance vector analysis (BIVA) were used to evaluate nutritional status and body composition.

RESULTS

The indicators revealed a generally good nutritional status. The MNA results (men: 24.6 +/- 2.2; women: 23.4 +/- 2.5) showed that 64.1% of the subjects had a normal nutritional status and only a small proportion (1.2%) could be classified as malnourished. BIVA showed that most subjects (74.2%) were normal, while the prevalence of low body cell mass was 10.7% and that of dehydration 11.2%. According to the MNA, the nutritional status was significantly better in the men. Almost three-quarters of the men (73.1%) were well nourished vs. half of the women (50.6%). A worsening of the nutritional status with age was observed. The proportion of malnourished individuals, as assessed by MNA, increased from 0% to 9.1% from 70-79 to > 90 years.

CONCLUSIONS

With respect to their contemporaries from other regions, the elderly of Orroli presented a better nutritional status, a similar worsening with age and generally higher sexual dimorphism.

Food security in older adults: community service provider perceptions of their roles

Food insecurity in older adults is influenced by financial constraints, functional disability, and isolation. Twenty-eight social- and community-service providers participated in four focus groups to report (a) perceptions and experiences with food insecurity in their older clients, (b) beliefs about their potential role(s) in promoting food security, and (c) opinions about constraints that influenced these roles. A constant comparison analysis identified key themes. The formal caregivers reported six roles for improving food security: (a) monitoring, (b) coordination, and (c) promoting services, (d) education, (e) advocacy, and (f) providing a social environment. The final theme summarizes these roles as "the need for personalization of service". Social and community service providers are involved in roles that can promote the health of older adults by addressing their food insecurity. Social service providers need to be acknowledged and supported in this health promotion role.

Correction of nutrition test errors for more accurate quantification of the link between dental health and malnutrition

OBJECTIVE

We quantified the link between tooth deterioration and malnutrition in institutionalized elderly subjects, taking into account the major risk factors for malnutrition and adjusting for the measurement error made in using the Mini Nutritional Assessment questionnaire.

METHODS

Data stem from a survey conducted in 2005 in 1094 subjects >or=60 y of age from a large sample of 100 institutions of the Rhône-Alpes region of France. A Bayesian approach was used to quantify the effect of tooth deterioration on malnutrition through a two-level logistic regression. This approach allowed taking into account the uncertainty on sensitivity and specificity of the Mini Nutritional Assessment questionnaire to adjust for the measurement error of that test.

RESULTS

After adjustment for other risk factors, the risk of malnutrition increased significantly and continuously 1.15 times (odds ratio 1.15, 95% credibility interval 1.06-1.25) whenever the masticatory percentage decreased by 10 points, which is equivalent to the loss of two molars. The strongest factors that augmented the probability of malnutrition were deglutition disorders, depression, and verbal inconsistency. Dependency was also an important factor; the odds of malnutrition nearly doubled for each additional grade of dependency (graded 6 to 1). Diabetes, central neurodegenerative disease, and carcinoma tended to increase the probability of malnutrition but their effect was not statistically significant.

CONCLUSION

Dental status should be considered a serious risk factor for malnutrition. Regular dental examination and care should preserve functional dental integrity to prevent malnutrition in institutionalized elderly people.

Meal programs improve nutritional risk: a longitudinal analysis of community-living seniors

OBJECTIVE

To determine the independent association of meal programs (eg, Meals On Wheels and other meal programs with a social component) and shopping help on seniors' nutritional risk.

DESIGN

Cohort design. Baseline data were collected with an in-person interview and subjects were followed up for 18 months via telephone interview.

SUBJECTS/SETTING

Cognitively well, vulnerable (ie, required informal or formal supports for activities of daily living) seniors were recruited through community service agencies in southwestern Ontario, Canada. Three hundred sixty-seven seniors participated in baseline interviews and 263 completed data collection at 18-month follow-up; 70% participated in meal programs at baseline.

MAIN OUTCOME MEASURES

The 15-item Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN) questionnaire identified nutritional risk at 18 months.

STATISTICAL ANALYSES PERFORMED

Descriptive and bivariate analyses were performed and significant associations (P<0.05) used to build the full multiple linear regression model. Meal and shopping variables were forced into the model as predictors of follow-up SCREEN questionnaire scores.

RESULTS

Meals On Wheels use was independently associated with higher SCREEN questionnaire scores (ie, less risk), as was higher income. Baseline SCREEN questionnaire scores also strongly and positively predicted follow-up scores. Self-reported depression at baseline was associated with lower scores at follow-up. Although use of programs at baseline was associated with decreased risk, if participants experienced increased use of the program (eg, more meals) during the follow-up period this was associated with lower scores, or increased risk.

CONCLUSIONS

Meal programs can improve or maintain nutritional risk for vulnerable seniors. Increased use of these programs over time may indicate a senior's declining status. Seniors who are in need of informal or formal supports for food shopping or preparation should be encouraged to participate in meal programs as a means of maintaining or improving their nutrition.